Perforated Nasal Septum May Facilitate the Occurrence of Atrophic Rhinitis!

Septum perforation occurred after nose surgery and atrophic rhinitis

The intranasal endoscopic photographs of a patient who had previously undergone nasal surgery in a different clinic and who developed post-operative nasal crusting, dryness and occasional pain were shared above and below. As seen in the photos, the patient has a perforation of the nose septum about one and a half centimeters in front of the nasal septum, drying and crusting of both lower and middle nasal turbunates. Especially in patients with septum perforation, since there is an accelerated intranasal airflow, drying of the nasal mucosa occurs in areas where the air hits.

When you look at the turbinates of the inferior, it is seen that the front parts are installed as if sanded with a metal tool and the roughener. In patients with nasal septum perforation resulting from such surgical procedures, regular rinsing of the nose with saline, use of moisturizing drops may prevent the occurrence of atrophic rhinitis. When the left nasal cavity is examined, it is seen that the mucosa is drier and there are yellowish, inflammatory crusts extending to the middle meatus. The patient was scheduled for several weeks of intensive nasal moisturizing treatment followed by closure of the nasal septum perforation.

Perforation of the nasal septum facilitates the occurrence of atrophic rhinitis

Depending on the location and size of the nasal septum perforation, clinical symptoms may occur. In this article, the symptoms may be higher in perforations located in the anterior part of the nasal septum, as in the case of the patient with whom you share. When the patient breathes, a whistling sound occurs, and the perforation edges are light and dry, and both inferior turbinate is very dry. Humidification, heating and purification of the nasal mucosa can be performed in patients with normal intranasal air resistance; In patients with abnormally accelerated airflow as in this case, because air enters over the nasal mucosa's ability to heat air, dry, particulate air is delivered back through the nose, into the nasal region, and into the lungs. You can only see dryness and crusting in the nose in the photos of the patient you see here, but the patient's throat examination and lower respiratory tract examination also show mucosal dryness other than nasal dryness.

Causes atrophic rhinitis?

Atrophic rhinitis is a chronic mucosal inflammation that results in damage to the nasal mucosa. It can often be accompanied by virus, bacterial or fungal infections. Many different types of bacteria may be involved in inflammation of the mucosa. Generally, many factors can facilitate the occurrence of atrophic rhinitis. For example, in addition to bacterial infections, allergy, chronic dryness of the nasal mucosa, prolonged inhalation of dry and dusty air, contact with intense contaminated air, and prolonged mucosal viral infections may facilitate the occurrence of atrophic rhinitis. Some forms can be contagious.

Risk factors for atrophic rhinitis

The risk factors for atrophic rhinitis may be hereditary factors, hormonal imbalances, nutritional deficiencies (eg vitamin A, vitamin D and iron deficiency), racial features, autoimmune factors, and surgical traumas. It is usually more common in women and more common in people with low socioeconomic status.

Clinical manifestations of atrophic rhinitis

In patients with atrophic rhinitis, during the endoscopic nasal examination, the mucosa in the nose is usually dry, red in color and may contain dark, greenish, and dry crusts on the mucosa. Sometimes painful stimuli may occur in these areas and the crust within the nose may fall behind and in front of the nasal passages. There is usually an infection involving many microorganisms. Odor may develop through the nose. Generally, patients may not be aware of the odor associated with mucosal inflammation and chronic infection in the nose. Sources refer to this as "merciful anosmia" or "merciful or bestowal smell disorder." Nasal congestion may occur due to mucosal inflammation within the nose, and permanent changes in the nasal mucosa may occur over time. Drying may occur.

How is atrophic rhinitis treated?

Medical treatment of atrophic rhinitis

Different treatments can be applied in the treatment of atrophic rhinitis such as using intranasal regular saline washing, using moisturizing solutions in the nose, using alkaline nasal solutions, applications with local antibiotics, taking vitamin D2 (calciferol) and using estrogen containing sprays in order to increase the epidemic in the nose. In addition, systemic streptomycin antibiotics can be used. It is available in different applications such as oral potassium-containing solutions and injection of placenta extract into the mucosa.

Surgical treatment of atrophic rhinitis

Surgical treatment of atrophic rhinitis usually involves operations such as Young and Modified Young to reduce the air cross-sectional area within the nose. Submucosal injections in the lower meautus within the nose can be used with teflon filling. In addition, surgical procedures involving transposition of parotid salivary gland secretion into the maxillary sinus or mucosa have been described but not widely accepted.

In the photo above, a large nasal septum perforation is visible on rhinoscopic examination. Since the operation was planned for the patient, regular nasal saline irrigation was recommended before the operation, and in this examination performed before the operation, it is seen that the nasal mucosa is relatively healthy due to the rapid airflow. In order to prevent drying and adverse effects on the nasal mucosa, and to increase the surgical success rate in patients with nasal septum perforation, it may be recommended to start irrigation with nasal saline 1 month before the operation, to avoid smoking and salty foods, and to avoid mixing the nose with a finger or napkin (mechanical trauma).

The above photograph shows dry and crusty nasal mucosa in a patient with large nasal septum perforation. The abnormal acceleration of the air flow entering the patient's nose and the fact that the nose starts to function as a single cavity cause chronic mucosal changes.
These patients should regularly wash the inside of the nose with natural seawater sprays, avoid drinks such as tea and coffee that dry the nasal mucosa, do not insert napkins or fingers into the nose, and should be followed by an otolaryngologist. In these patients, simple internal nasal septal button insertion may cause enlargement of the perforation and infection at the perforation margins. Although millimetric closure success cannot be guaranteed with a single operation, I usually recommend surgical treatment for patients with septal perforation that is this large, even for the sole purpose of reducing it.

Similar links >> Modified Young Procedure and Septum Correction Surgery / Boş Burun Sendromu Olan Hastalarda, Septum Perforasyonu da Ortaya Çıkarsa Belirtiler Şiddetlenir! / Atrophic Rhinitis - Definition, Symptoms, Diagnosis, Treatment

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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